The use of 20-mcg oral contraceptives (OCs) is gaining ground, as more providers are using them in a wider range of women. A pharmaceutical market research firm has pegged US prescriptions of such pills at 14%, and Contraceptive Technology Update readers see an uptick in their use. A study that compared two 20-mcg pills against a 35-mcg formulation indicates that, while cycle control was similar among all three products, estrogenic side effects were 50% more common in women using the 35-mcg pill. A total of 463 women were randomized to use one of the three OC products, which were to be used for six menstrual cycles. In this three-way comparison, it was found that there were fewer estrogenic effects and equivalent cycle control and contraceptive efficacy in users of two 20-mcg ethinyl estradiol (EE) preparations as compared to women using a 35-mcg EE OC. However, proper pill taking is noted to be an important component in ensuring the effectiveness of any OC. Hence, clinicians should provide thorough education on pill usage with 20-mcg pills because they might be less forgiving of a missed pill in the daily regimen.